State of emergency

EMS crews reach their destination in less than nine minutes only 62 per cent of the time, not a happy circumstance when every minute counts.

The question of Rob Ford's mayoralty may be up in the air, but his impact continues to wreak havoc on the budget process.

Last week the Budget Committee proposed major cuts to Fire Services despite the fact that the department's resources are substandard by industry benchmarks. Four local fire stations could wind up with one truck instead of two, and the Runnymede station might be abolished altogether.

And this week the showdown continues to play out between Ford's supporters on the Police Services Board and Chief Bill Blair, who believe that a budget freeze that decreases the number of officers puts residents at risk.

Add to these high-profile cuts the lesser-known hold on any new cash for Emergency Medical Services (EMS) and you can see that the city is at the point of having difficulty fulfilling its primo mandate: protecting the security of person and property. All to save $5 on the average tax bill.

A look at the EMS budget freeze (which equals diminished resources) illustrates how our growing population is putting dangerous pressure on already strained services. EMS responded to calls in 8.59 minutes or less 84 per cent of the time in 1996. Today, with more traffic, more calls and basically static resources, EMS reaches destinations in less than nine minutes only 62 per cent of the time - not a happy circumstance in emergencies, when every minute counts.

Today we have 851 paramedics using 155 vehicles (ambulances and response cars), one paramedic for every 3,500 residents. Between 1998 and 2011, EMS volume went up 47 per cent, but only 10 new hires were made. While this may sound great to the no-tax crowd, the situation is not sustainable given our growing and aging population.

But EMS is not just about emergency response, although this is its major function. It also works with Toronto Public Health on immunization, administers over 1,200 automatic external defibrillators, helps the vulnerable through community clinics and transfers hospital patients.

The mayor and his budget-cutters refuse to accept that whatever the possible efficiencies, the reality is that it's impossible to improve or even maintain levels of service without allowing EMS to hire.

In some cases, increasing staff might actually save dollars. Between 1999 and 2010, for example, EMS overtime more than doubled, showing that sometimes keeping staffing at the same level can be costly.

True, there is some luxury in the system, but do we really want to let go of it? Toronto offers some of the best quality EMS on the continent in the sense that ambulances always have a level-III paramedic on board who can administer treatment and stabilization drugs and do other advanced procedures. Though many other jurisdictions in Canada and the U.S. may reap savings from paying lower salaries to those with lower qualifications, their emergency workers are limited in their function to simple transport. Surely this is not where to look for tiny cost savings.

So, too, it wouldn't be prudent to raise ambulance fees. The total EMS budget in 2013 is projected to be just under $170 million. Only $65 million comes from taxes; the rest is recovered from passengers who pay from $45 to $240 a trip, depending on whether it's deemed "medically necessary." Raising those rates would put an increased burden on those who can least afford it, and would go against the principles of our medical system, which sees fees for basic service as unfair.

We also have to recognize that there have already been major cost-saving improvements. By 2008, the average time an EMS team waited in emergency wards to turn patients over to nursing staff was 63 minutes. This cost EMS over $6 million. New hospital off-load nurses funded by the province have saved us millions of dollars by shrinking that time to 46 minutes in 2011.

EMS has also reduced the number of non-emergency patient transfers from 58,000 to 10,000 in 2011, and their cost is transferred to the provincial budget or to the patient.

Over the last few years, EMS management has developed successful band-aid solutions to deal with traffic congestion and the increasing number of calls. One is the use of paramedic vehicles to augment the ambulance fleet, a concept that could be expanded.

But not all new ideas are good ideas. One solution now being floated, the consolidation of EMS with Toronto Fire (the subject of a study set to be released in February), isn't likely to remedy the staffing shortfall at all. We know from experience elsewhere that larger organizations are not always more efficient. The fact is, even if better ways of delivering services are found, there's no way around it: like it or not, EMS needs more bodies on the ground. It's as simple as that.